Development of a computerized 2D rating scale for continuous and simultaneous evaluation of two dimensions of a sensory stimulus

INTRODUCTION One-dimensional rating scales are widely used in research and in the clinic to assess individuals' perceptions of sensory stimuli. Although these scales provide essential knowledge of stimulus perception, their limitation to one dimension hinders our understanding of complex stimuli. METHODS To allow improved investigation of complex stimuli, a two-dimensional scale based on the one-dimensional Gracely Box Scale was developed and tested in healthy participants on a visual and an auditory task (rating changes in brightness and size of circles and rating changes in frequency and sound pressure of sounds, which was compared to ratings on one-dimensional scales). Before performing these tasks, participants were familiarized with the intensity descriptors of the two-dimensional scale by completing two tasks. First, participants sorted the descriptors based on their judgment of the intensity of the descriptors. Second, participants evaluated the intensity of the descriptors by pressing a button for the duration they considered matching the intensity of the descriptors or squeezing a hand grip dynamometer as strong as they considered matching the intensity of the descriptors. RESULTS Results from these tasks confirmed the order of the descriptors as displayed on the original rating scale. Results from the visual and auditory tasks showed that participants were able to rate changes in the physical attributes of visual or auditory stimuli on the two-dimensional scale as accurately as on one-dimensional scales. DISCUSSION These results support the use of a two-dimensional scale to simultaneously report multiple dimensions of complex stimuli

Treatment of Fibromyalgia with Formula Acupuncture: Investigation of Needle Placement, Needle Stimulation, and Treatment Frequency

Objectives: The objective of this study was to investigate whether typical acupuncture methods such as needle placement, needle stimulation, and treatment frequency were important factors in fibromyalgia symptom improvement. Design/settings/subjects: A single-site, single-blind, randomized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed. Intervention: Participants were randomized to one of four treatment groups: (1) T/S needles placed in traditional sites with manual needle stimulation (n = 29): (2) T/0 traditional needle location without stimulation (n = 30); (3) N/S needles inserted in nontraditional locations that were not thought to be acupuncture sites, with stimulation (n = 28); and (4) N/0 nontraditional needle location without stimulation (n = 2 7). All groups received treatment once weekly, followed by twice weekly, and finally three times weekly, for a total of 18 treatments. Each increase in frequency was separated by a 2-week washout period. Outcome measures: Pain was assessed by a numerical rating scale, fatigue by the Multi-dimensional Fatigue Inventory, and physical function by the Short Form–36. Results: Overall pain improvement was noted with 25%–35% of subjects having a clinically significant decrease in pain; however this was not dependent upon "correct" needle stimulation (t = 1.03; p = 0.307) or location (t = 0.76; p = 0.450). An overall dose effect of treatment was observed, with three sessions weekly providing more analgesia than sessions once weekly (t = 2.10; p = 0.039). Among treatment responders, improvements in pain, fatigue, and physical function were highly codependent (all p ≤ 0.002). Conclusions: Although needle insertion led to analgesia and improvement in other somatic symptoms, correct needle location and stimulation were not crucial.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63411/1/acm.2005.11.663.pd

Knee pain and radiographic osteoarthritis interact in the prediction of levels of self-reported disability

Objective To determine predictors of disability depending on whether joint deformity and pain reporting exist independently or concurrently. Methods Subjects were 154 volunteers for an osteoarthritis screening examination. Eligible subjects completed questionnaires for physical function, pain, and depressive symptoms; underwent evoked pain testing for tenderness assessment; and had anteroposterior and lateral radiographs taken of both knees. Two blinded rheumatologists scored the images using Kellgren-Lawrence criteria to determine presence of deformity. Results Subjects were divided into 3 subgroups based on radiographic evidence of deformity and self-reported pain. Disability was greatest when pain and deformity occurred together (F[2,151] = 18.8, P < 0.0001). Self-reported disability in the absence of deformity was predicted by body mass index, pain threshold, and anxiety symptoms; disability was predicted by the number of osteophytes and depressive symptoms when pain and deformity occurred together. Conclusion Self-reported disability in osteoarthritis of the knee is greatest with concurrent pain and joint deformity. When pain and deformity do not cooccur, disability appears to be related to separate factors, including anxiety and pain threshold (e.g., tenderness).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34314/1/20537_ftp.pd

A Randomized, Controlled Investigation of Motor Cortex Transcranial Magnetic Stimulation (TMS) Effects on Quantitative Sensory Measures in Healthy Adults: Evaluation of TMS Device Parameters

There is emerging evidence that transcranial magnetic stimulation (TMS) can produce analgesic effects in clinical samples and in healthy adults undergoing experimentally induced pain, and the field of minimally invasive brain stimulation for the management of pain is expanding rapidly. While, motor cortex is the most widely used cortical target for TMS in the management of neuropathic pain, few studies have systematically investigated the analgesic effects of a full range of device parameters to provide initial hints about what stimulation intensities and frequencies are most helpful (or even potentially harmful) to patients. Further, there is considerable inconsistency between studies with respect to laboratory pain measurement procedures, TMS treatment parameters, sophistication of the sham methods, and sample-sizes. The present study employed a sham-controlled, within-subject, cross-over design to examine the effects of five different TMS treatment parameters across several quantitative sensory measures in a sample of healthy adult volunteers. 65 participants underwent quantitative sensory testing procedures pre- and post- 40-minutes of real and sham motor cortex TMS. TMS was delivered at 1Hz 80% resting motor threshold (rMT), 1Hz 100%rMT, 10Hz 80%rMT, 10Hz 100%rMT, or 50Hz triplets at 90% of active motor threshold (intermittent theta-burst). The mean painfulness rating of real TMS stimulation itself was 3.0 (SE=.36) out of 10 and was significantly greater than zero (t(64)=8.17, p<.0001). The sham TMS methods used permitted matching between real and sham TMS-induced scalp sensations and participants were successfully blinded to condition (real versus sham). Findings suggest that the effects of motor cortex TMS on quantitative sensory tests in healthy adults vary across different treatment parameters with the smallest observed effect for intermittent theta-burst stimulation (Cohen's d=0.03) and the largest for 10Hz 100%rMT (d=.34). Overall, TMS was associated with statistically significant effects on warm and cool sensory thresholds, cold pain thresholds, suprathreshold stimulus unpleasantness ratings and wind-up pain. With respect to device parameter effects, higher frequency stimulation appears to be associated with the most analgesic and anti-sensitivity effects with the exception of intermittent theta-burst stimulation. The present findings support several clinical research findings suggesting that higher TMS frequencies tend to be associated with the most clinical benefit in patients with chronic pain

A Novel Tool for the Assessment of Pain: Validation in Low Back Pain

Joachim Scholz and colleagues develop and validate an assessment tool that distinguishes between radicular and axial low back pain

The Influence of Cutaneous Tissue Afferents on Masticatory Pain-Pressure Thresholds

Pain-pressure thresholds are routinely used in orofacial pain research to record tenderness in masticatory muscles. This method is employed to stimulate deep tissue afferents, which are thought to be at least partially responsible for pain in temporomandibular disorders. Like other psychophysical measurements, however, this technique must stimulate cutaneous tissues before stimulating deeper tissues. This study examined 39 asymptomatic volunteers to quantify the effect of cutaneous sensory afferents on pain-pressure thresholds. In a randomized, double-blind fashion, pain-pressure thresholds were recorded at four facial sites before and after subjects received intradermal local anesthetic or a dry needle stick. Pain-pressure thresholds were significantly elevated after local anesthetic (P \u3c .0001), suggesting that cutaneous tissues contribute significantly to the pain-pressure threshold. The authors discuss potentially important roles of cutaneous tissues in the assessment of deeper tissues and offer two theories of how the skin may be an important link in the assessment of temporomandibular disorders

Influence of a Sympathomimetic Amine on Masticatory and Trapezius Pain/Pressure Thresholds and Electromyographic Levels

Objectives. This study examined the influence of terbutaline, a β-adrenergic sympathomimetic amine on pain/pressure thresholds in the index fingers and masseter and trapezius muscles and electromyographic activity in trapezii. Study design. In a randomized and double-blind controlled trial, 20 asymptomatic female subjects were assigned to receive either an injection of terbutaline or sterile water before collection of pain/pressure thresholds and electromyographic levels. Repeated analysis of variance and paired t tests were calculated to test for baseline and postinjection differences between groups. Results. No significant baseline or postinjection group differences in pain/pressure thresholds or electromyographic were detected. Conclusions. β-adrenergic sympathomimetic stimulation does not influence pain/pressure thresholds or electromyographic activity in the masselet and trapezius muscles or pain/pressure thresholds in the index fingers. These results suggest that development of painful muscle conditions is not caused by elevations of sympathetic activity

Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research

There is growing awareness that dyspnoea, like pain, is a multidimensional experience, but measurement instruments have not kept pace. The Multidimensional Dyspnea Profile (MDP) assesses overall breathing discomfort, sensory qualities, and emotional responses in laboratory and clinical settings. Here we provide the MDP, review published evidence regarding its measurement properties and discuss its use and interpretation. The MDP assesses dyspnoea during a specific time or a particular activity (focus period) and is designed to examine individual items that are theoretically aligned with separate mechanisms. In contrast, other multidimensional dyspnoea scales assess recalled recent dyspnoea over a period of days using aggregate scores. Previous psychophysical and psychometric studies using the MDP show that: 1) subjects exposed to different laboratory stimuli could discriminate between air hunger and work/effort sensation, and found air hunger more unpleasant; 2) the MDP immediate unpleasantness scale (A1) was convergent with common dyspnoea scales; 3) in emergency department patients, two domains were distinguished (immediate perception, emotional response); 4) test–retest reliability over hours was high; 5) the instrument responded to opioid treatment of experimental dyspnoea and to clinical improvement; 6) convergent validity with common instruments was good; and 7) items responded differently from one another as predicted for multiple dimensions